Ruminations by a non-academic general surgeon from the heart of the rust belt.

Thursday, January 7, 2010

Speed

A paper that extrapolates data from the American College of Surgeon's NSQIP database demonstrates that infectious complications in general surgery cases rise linearly with increased duration of operating times.

The lesson as always: Don't dick around. Don't waste time or motion. Get in and get out.

"Multivariable regression adjusted for 38 patient risk variables, operation type and complexity, wound class and intraoperative transfusion. We also analyzed isolated laparoscopic cholecystectomies in patients of American Society of Anesthesiologists class 1 or 2, without intraoperative transfusion and with a clean or clean-contaminated wound class"

For the "complexity of the case" concept, above. I would think "bad surgeons take longer" is oversimplifying a bit.

HH-Often bad surgeons do take more time. But there are also hacks who rush through an operation and end up with bad outcomes. You dont want to dither and waste time; but you also dont want to be overconfident and careless when doing an operation. The paper cited compares OR time on similar operations. Thus, no matter how complex a case (gallbladder, colon, etc) the longer it takes compared to average casetime of similar cases, the higher the infection rate. This actually isnt new information. There's plenty of ammunition in the surgical literature that supports OR time as an independent risk factor for infection rates. It's just nice to see it compiled from the enormous NSQIP database

HH-There's an extensive database of literature that supports use of prophylactic antibiotics to reduce SSI rates. (see http://www.cochrane.org/reviews/en/ab005360.html for example)

The issue of operating time is just another independent risk factor for developing surgical site infections.

THink of it this way: The risk factors for development of SSI's are as follows:-not using periop antibiotics-morbid obesity-contaminated wounds (perfed bowel)-long OR times-immunosupressed states-diabetics

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